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Introduction Over the past two decades, the incidence of acute rheumatic fever (ARF) and chronic rheumatic heart disease (RHD) have dramatically declined in wealthier regions of the world as a result of preventative programmes, improved living standards and access to cardiac surgery. Nevertheless, ARF and RHD are still public health problems in less-developed regions of the world such as Oceania, south Asia and sub-Saharan Africa. Aim We report on clinical, therapeutic and prognostic aspects as well as the difficulties encountered during this first series of surgery for rheumatic valve disease in Mali. Methods This was a prospective, descriptive study conducted at the Andre Festoc Cardiac Surgery Centre from September 2018 to August 2019. Results The frequency of patients having been operated on for rheumatic valve disease was 44.73% (68 patients). The mean age of the patients was 18 ± 10 years with extremes of five and 60 years. The gender ratio was 0.7. The delay to treatment was between one and three years for 39.7% of the patients. The main diagnoses found were: mitral regurgitation in 50% of patients, mitral stenosis in 16.2% and aortic regurgitation in 10.3%. Pulmonary artery systolic pressure was 35-50 mmHg in 19.1% of patients and more than 50 mmHg in 25%. The median cardiopulmonary bypass time was 132 minutes (60-276) and median extubation time was three hours (0-96). The main complications were cardiac, renal, neurological, respiratory, gastrointestinal and infectious. In the immediate postoperative period, we recorded three deaths, which is a mortality rate of 4.4%. Conclusions Humanitarian efforts have led non-governmental organisations (NGOs) to launch surgical programmes in low-and middle-income countries in an attempt to fill the gap in these fragile healthcare systems. Cardiac surgery requires much expertise from the medical staff, as well as many material and financial resources. Empowerment of the local team is a challenge that is being realised since taking these essential steps of companionship with the NGO la Chaine de l'Espoir.

Objectif : L’objectif était d’apporter une mise à jour des données épidémiologiques, évaluer la prise en charge de ces envenimations et faire ressortir les facteurs pronostiques de ces affections dans notre contexte. Patients et Méthodes : Il s’agissait d’une étude prospective transversale allant du 01 Février 2019 au 31 Janvier 2020, ont été inclus à l’étude tous patients admis au service d’accueil des urgences du CHU Gabriel TOURE de Bamako pour envenimation par morsure de serpent. Les caractéristiques démographiques, cliniques, paracliniques, thérapeutiques ont été relevées sur une fiche d’exploitation préalablement établie. Les données ont été saisies sur WORD 2013 et analysées sur SPSS 21. Résultats : 126 cas d’envenimations ont été inclus à l’étude. L’âge moyen des patients était de 25 ans ; le sexe masculin représentait 63,5% des cas. La période hivernale était la période de prédilection des morsures. Le délai de consultation était > 72H dans 40,5%. Un syndrome hémorragique était présent dans 77% des cas. L’hémopéritoine de grande abondance, l’hémorragie intracrânienne, les fausses couches et l’insuffisance rénale étaient les principales complications rencontrées. Nous avons enregistré une mortalité de 10%. Conclusion : Des progrès ont été observés quant à l’approvisionnement en SAV au Mali depuis 2016. Au Mali, l’incidence et la gravité de cette pathologie restent encore mal connues. Les études réalisées sur ce sujet sont rares et se limitent à quelques centres hospitaliers. Une meilleure évaluation de l’incidence et de la morbidité est pourtant indispensable pour améliorer la prise en charge.

Introduction: Health care-associated infection is an infection acquired during the care delivered in the hospital or in any other care establishment which was neither present, nor in incubation at the admission of the patient or at the time of delivering the care or which does not manifest itself only after the patient has been discharged or an infection contracted by the professional in the course of his duties. Objectives: To identify mean causative germs and to determine their sensitivity to antibiotics and to identify the risk factors of health care-associated infection. Material and methods: It was about a prospective longitudinal study conducted from November 1, 2017 to April 1, 2018 (6 months) in all children admitted to the pediatric surgery service. Non-consenting parents and outpatient necrosectomy case have not been included in this study. Results: This study included 200 patients, of whom 30 experienced the hospital acquired infections with an infection rate of 15%. The surgical site infection was the most common type, with 16 cases (53.3%), followed by burns in 13 cases (43.3%) and urinary tract infection in 1 case (3.3%). The average age of patients with infection was 56.33 ± 48.66 months with extremes of 1 and 180 months. The sex ratio was 1.30 for infected patients and was 1.83 for uninfected patients. The main bacteria responsible for surgical site infection were: Escherichia coli (4 cases), Acinetobacter baumanii (3 cases), Klebsiella pneumoniae (2 cases), Staphylococcus aureus (2 cases), Enterobacter cloacae (1 case), Pseudomonas aeruginosa (1 case) and Enterobacter faecalis (1 case). Among burn patients, the most frequent germs were: Acinetobacter baumanii (7 cases), Klebsiella pneumoniae (6 cases), Staphylococcus aureus (6 cases), Escherichia coli (4 cases), Pseudomonas aeruginosa (2 cases) and Enterobacter faecalis (2 cases). Escherichia coli was noted only in the case of urinary tract infection. Antibiotics tested were: amoxicillin, amoxicillin associated with clavulanic acid, ceftriaxone, imipenem, gentamicin and ciprofloxacin. Germs were resistant to amoxicillin in 88.9% of cases, sensitive to the amoxicillin-clavulanic acid combination in 85% of cases, sensitive to tobramycin and gentamicin. Recruitment methods and length of hospitalization were the risk factors noted. Conclusion: Massive awareness among all healthcare providers should be conducted on the adoption of standard precautions for the prevention of health care-associated infections and on the rules of antibiotics prescription to reduce the incidence of health care-associated infection and slow the resistance of germs to antibiotics.

The Pica syndrome is an eating disorder characterized by an excessive or abnormal desire to consume a non-nourishing substance which can be relatively harmless, or potentially harmful for the health. It is a rare affection secondary to the accumulation of diverse nature foreign bodies inside the digestive tract and more especially at the stomach level. Gastro-intestinal localization is the most frequent, and can remain long time asymptomatic. Treatment is surgical. We report 3 cases of digestive complication of Pica syndrome. The first one was operated for gastric perforation due to nail (53 nails, a pin and bands of tape recorder cassette ingested), the second one for trichobezoar and the last had a subocclusion by pieces of granite.

Pneumomediastinum is sometimes observed in adult patients but its occurrence in pediatric patients (especially infants) is very rare. We here report a 14-month-old male infant who had subcutaneous emphysema, pneumomediastinum, and importantly, pneumopericardium. He had no particular past histories. He abruptly had cough, fever, and eruption on the abdomen. Computed tomography and echocardiography revealed pneumomediastinum and pneumopericardium. Antibiotics, rest, and supportive therapy ameliorated the condition. We must be aware that pneumomediastinum, and importantly pneumopericardium, can be present in a pediatric patient with subcutaneous emphysema. The infant’s symptoms disappeared under strict monitoring of respiratory status, nasal oxygen therapy and antibiotic therapy.

Background Typhoid fever incidence and complications, including intestinal perforation, have declined significantly in high-income countries, with mortality rates Methods We searched EMBASE, PubMed, Medline, and Cochrane databases for studies reporting mortality rates due to typhoid intestinal perforation in children, under 18 years old, in sub-Saharan Africa published from January 1995 through June 2019. Results Twenty-four papers from six countries were included. Reported mortality rates ranged from 4.6–75%, with 16 of the 24 studies between 11 and 30%. Thirteen papers included postoperative morbidity rates, ranging from 16–100%. The most documented complications included surgical site infections, intra-abdominal abscesses, and enterocutaneous fistulas. High mortality rates can be attributed to late presentation to tertiary centers, sepsis and electrolyte abnormalities requiring preoperative resuscitation, prolonged perforation-to-surgery interval, and lack of access to critical care or an intensive care unit postoperatively. Conclusions Current estimates of mortality related to typhoid intestinal perforation among children in sub-Saharan Africa remain unacceptably high. Prevention of typhoid fever is essential to reduce mortality, with the ultimate goal of a comprehensive approach that utilizes vaccination, improvements in water, sanitation, and hygiene, and greater access to surgical care.

Objective: Pediatric jaundice is caused by various conditions. Although some data is available on this issue, data from Mali is insufficient. The present retrospective observational study was an attempt to determine the etiology of pediatric jaundice in the pediatric department of Gabriel Toure teaching hospital in Bamako, Mali. Methods: We reviewed all pediatric patients with jaundice who were hospitalized and treated in this department during January 1 to December 31, 2016 (n = 168). Result: Pediatric jaundice patients accounted for 1.88% of the hospitalized patients, with median age of 6 years and male/female ratio being 1.6. Infectious, cholestatic, and hemolytic jaundice accounted for 75%, 11% and 10%, respectively. Malaria and sickle cell disease accounted for 67% and 9%, respectively. Hepatomegaly and splenomegaly were observed in 49 (29%) and 23 (13.7%) patients, respectively. Of 168, 9 patients died. Conclusion: Infectious jaundice, especially jaundice due to malaria, was the most frequent. However, variety of etiologies was observed, of which the practitioners should be aware. The observation presented here may become fundamental data in health-policy making in this area.

Background In Mali, nomadic populations are spread over one third of the territory. Their lifestyle, characterized by constant mobility, excludes them from, or at best places them at the edge of, health delivery services. This study aimed to describe nomadic populations’ characteristics, determine their perception on the current health services, and identify issues associated with community-based health interventions. Methods To develop a better health policy and strategic approaches adapted to nomadic populations, we conducted a cross-sectional study in the region of Timbuktu to describe the difficulties in accessing health services. The study consisted in administering questionnaires to community members in the communes of Ber and Gossi, in the Timbuktu region, to understand their perceptions of health services delivery in their settings. Results We interviewed 520 individuals, all members of the nomadic communities of the two study communes. Their median age was 38 years old with extremes ranging from 18 to 86 years old. Their main activities were livestock breeding (27%), housekeeping (26.4%), local trading (11%), farming (6%) and artisans (5.5%). The average distance to the local health center was 40.94 km and 23.19 km respectively in Gossi and Ber. In terms of barriers to access to health care, participants complained mainly about the transportation options (79.4%), the quality of provided services (39.2%) and the high cost of available health services (35.7%). Additionally, more than a quarter of our participants stated that they would not allow themselves to be examined by a health care worker of the opposite gender. Conclusion This study shows that nomadic populations do not have access to community-based health interventions. A number of factors were revealed to be important barriers per these communities’ perception including the quality of services, poverty, lifestyle, gender and current health policy strategies in the region. To be successful, future interventions should take these factors into account by adapting policies and methods.

Background Ivermectin-based onchocerciasis elimination, reported in 2009–2012, for Bakoye and Falémé, Mali, supported policy-shifting from morbidity control to elimination of transmission (EOT). These foci are coendemic with lymphatic filariasis (LF). In 2007–2016 mass ivermectin plus albendazole administration was implemented. We report Ov16 (onchocerciasis) and Wb123 (LF) seroprevalence after 24–25 years of treatment to determine if onchocerciasis EOT and LF elimination as a public health problem (EPHP) have been achieved. Methods The SD Bioline Onchocerciasis/LF Ig[immunoglobulin]G4 biplex rapid diagnostic test (RDT) was used in 2186 children aged 3–10 years in 13 villages (plus 2 hamlets) in Bakoye and in 2270 children in 15 villages (plus 1 hamlet) in Falémé. In Bakoye, all-age serosurveys were conducted in 3 historically hyperendemic villages (1867 individuals aged 3 -78 years). Results In Bakoye, IgG4 seropositivity was 0.27% (95% confidence interval [CI] = .13%–.60%) for both Ov16 and Wb123 antigens. In Falémé, Ov16 and Wb123 seroprevalence was 0.04% (95% CI = .01%–.25%) and 0.09% (95% CI = .02%–.32%), respectively. Ov16-seropositive children were from historically meso/hyperendemic villages. Ov16 positivity was, Ov16–Wb123 (onchocerciasis– lymphatic filariasis [LF]) seroprevalence was measured in children aged ≤10 years to determine if onchocerciasis and elimination was achieved in 2 coendemic foci (Bakoye and Falémé) in Mali under long-term ivermectin treatment, which stopped in 2016. These goals seem to have been achieved.

Although Wuchereria bancrofti (Wb), the causative agent of lymphatic filariasis, is endemic throughout Mali, the prevalence of Wb microfilaremia (Mf) can vary widely between villages despite similar prevalence of infection as assessed by circulating antigen. To examine this variation, cross-sectional data obtained during screening prior to an interventional study in two neighboring villages in Mali were analyzed. The overall prevalence of Wb, as assessed by Wb CAg(circulating antigen), was 50.3% among 373 participants, aged 14-65. Wuchereria bancrofti Mf-positive and negative individuals appeared randomly distributed across the two villages (Moran's I spatial statistic = -0.01, Z score = 0.1, P>0.05). Among the 187 subjects positive for Wb CAg, 117 (62.5%) had detectable Mansonella perstans microfilaremia (Mp Mf) and 64 (34.2%) had detectable Wb microfilaremia. The prevalence of Mp microfilaremia was 73.4% in the Wb Mf-positive group (as compared to 56.9% in the Wb Mf-negative group; p=0.01), and median Wb Mf load was increased in co-infected subjects (267Mf/ml vs 100 Mf/ml; p

Background: Encephaloceles are congenital neural tube defects characterized by the protrusion of meninges and/or brain tissue from a defect in the skull. The incidence of the disease is about 0.8 - 5.6/10,000 live births. They are classified based on the location and type of skull defect as occipital encephalocele, encephalocele of the cranial vault, frontoethmoidal encephalocele, and basal encephaloceles. Surgical reduction being the first line treatment and resection of herniated structures may be necessary when the encephalocele is large. In the present study, the authors present their experience in treating 17 patients with encephaloceles. Methods: This study is a retrospective analysis of 17 patients from January 2013 to December 2016 in Gabriel Toure Hospital, Bamako, Mali. A history was obtained from the family at presentation. Medical information before and during the pregnancy was compiled. All patients underwent CT scan as a routine preoperative imaging study, to evaluate the encephalocele and to plan the surgical procedure. The following data were recorded for analysis: age, sex, location of encephalocele, neurological status, operative method, postoperative complications and surgical results. Results: There were 10 (58.8%) female and 7 (41.2%) male patients. The patients ranged in age from 3 days to 36 months. The most common site of encephalocele sac was the occipital region in 14 (82.4%) cases followed by the frontal region in 2 (11.8%) cases and the vertex in 1 (5.9%) case. The sac size was less than 3 cm in 5 (17.6%) cases, 3 - 5 cm in 8 (47.1%) cases and more than 5 cm in 4 (23.5%) cases. Three (17.6%) children presented with CSF leakage. Hydrocephalus was present in the preoperative period in 6 (35.3%) cases; all of them required VP shunt procedure. None of the cases had a preoperative neurologic deficit. Surgical excision was performed in all cases. In the postoperative period, meningitis developed in 2 cases (11.8%), wound infection in 1 case (5.9%) and seizure in 1 case (5.9%). Three patients (17.6%) died during postoperative follow-up. Postoperative hydrocephalus occurred in 1 (5.88%) patient requiring a VP shunt. Conclusion: Encephaloceles are commonly seen in the practice of neurosurgery in the world as well as in Mali. In this study, the clinical manifestations and surgical results of 17 cases have been reviewed. We recommend early repair and excision of encephaloceles to avoid rupture or skin excoriation.

Background Lymphedema is a public health problem in countries with lymphatic filariasis (LF) including Mali. We studied the epidemiology and clinical presentation of lymphedema in three previously LF-endemic health districts of Mali after at least five consecutive rounds of mass drug administration (MDA) with albendazole and ivermectin. Methods From 2016 to 2018, we used passive and active case finding methods to identify lymphedema cases in three health districts with high pre-MDA LF prevalence: Kolondieba (66%), Bougouni (44%) and Kolokani (34%). Results Three hundred and thirty nine cases of lymphedema were identified, 235 (69.32%) through active case finding. Their median age was 56 years (range 2–90) and 286 (84.36%) were women. Lymphedema was reported in 226 (78.5%) people aged 41 years and older compared to 73 (21.5%) people below the age of 41 years (Chi2 = 17.28, df = 5, p = 0.004). One hundred and seventy five cases of lymphedema were found in Kolondieba (66 per 100,000 people), 116 in Bougouni (19 per 100,000) and 48 in Kolokani (16 per 100,000). Stage III lymphedema was observed in 131 (38.64%), stage II in 108 (31.86%), stage IV in 46 (13.57%), stage I in 23 (6.78%), stage V in 21 (6.19%) and stage VI in ten (2.95%). In the three study districts, lymphedema affected the legs in 281 (82.89%), the arms in 42 (12.39%) and both in 16 (4.72%) (Chi2 = 13.63, p = 0.008). Conclusion Health districts in Mali with the highest pre-MDA LF prevalences had the highest prevalence of lymphedema. Efforts to actively identify lymphedema cases should be scaled up in previous LF-endemic areas, and should be supplemented by a morbidity management and disability prevention plan at the peripheral health system level.

Les envenimations ophidiennes constituent un probleme de sante publique en Afrique, entrainant 20 000 deces annuels. Cette mortalite traduit les difficultes de prise en charge des complications en particuliers hemorragiques. Nous rapportons le cas de Mr SL 35 ans, agriculteur, victime d'une morsure de vipere entrainant un syndrome hemorragique, suivi d'un abdomen aigu d'installation progressive. L'echographie objectivait un epanchement de grande abondance, dont la ponction ramenait du sang incoagulable. Devant la reconstitution de l'hemoperitoine apres trois doses de serum antivenimeux et la coagulation des prelevements sur tube sec, une laparotomie exploratrice etait realisee a J9. Elle a retrouve un hematome retro peritoneal bombant dans le meso-colon et qui s'ecoulait dans la cavite peritoneale. Le geste a consiste a une evacuation de 1500ml de sang, et un toilettage au serum physiologique. Les suites operatoires ont ete simples. Le patient etait transfere en secteur d'hospitalisation de chirurgie a J3 post operatoire puis sortie d'hopital a J19.

Background Mali has become increasingly interested in the evaluation of transmission of both Wuchereria bancrofti and Onchocerca volvulus as prevalences of both infections move toward their respective elimination targets. The SD Bioline Onchocerciasis/LF IgG4 Rapid Test was used in 2 evaluation units (EU) to assess its performance as an integrated surveillance tool for elimination of lymphatic filariasis (LF) and onchocerciasis. Methodology/Principal findings A cross sectional survey with SD Bioline Onchocerciasis/LF IgG4 Rapid Test was piggy-backed onto a transmission assessment survey (TAS) (using the immunochromatographic card test (ICT) Binax Filariasis Now test for filarial adult circulating antigen (CFA) detection) for LF in Mali among 6–7 year old children in 2016 as part of the TAS in two EUs namely Kadiolo-Kolondieba in the region of Sikasso and Bafoulabe -Kita-Oussoubidiagna-Yelimane in the region of Kayes. In the EU of Kadiolo- Kolondieba, of the 1,625 children tested, the overall prevalence of W. bancrofti CFA was 0.62% (10/1,625) [CI = 0.31–1.09]; while that of IgG4 to Wb123 was 0.19% (3/1,600) [CI = 0.04–0.50]. The number of positives tested with the two tests were statistically comparable (p = 0.09). In the EU of Bafoulabe-Kita-Oussoubidiagna-Yelimane, an overall prevalence of W. bancrofti CFA was 0% (0/1,700) and that of Wb123 IgG4 antibody was 0.06% (1/1,700), with no statistically significant difference between the two rates (p = 0.99). In the EU of Kadiolo- Kolondieba, the prevalence of Ov16-specific IgG4 was 0.19% (3/1,600) [CI = 0.04–0.50]. All 3 positives were in the previously O. volvulus-hyperendemic district of Kolondieba. In the EU of Bafoulabe-Kita-Oussoubidiagna-Yelimane, an overall prevalence of Ov16-specific IgG4 was 0.18% (3/1,700) [CI = 0.04–0.47]. These 3 Ov16 IgG4 positives were from previously O.volvulus-mesoendemic district of Kita. Conclusions/Significance The SD Bioline Onchocerciasis/LF IgG4 Rapid test appears to be a good tool for integrated exposure measures of LF and onchocerciasis in co-endemic areas., Author summary After years of mass drug administration for lymphatic filariasis and onchocerciasis, many co-endemic countries need to demonstrate the interruption of transmission of these parasitic infections. This interruption of transmission is the key to stopping mass drug administration. One of the major challenges facing national programs is a reliable point of care diagnostic tool capable of detecting recent infection in children. To this end, the SD Bioline Onchocerciasis / LF IgG4 Rapid Test was used to evaluate the transmission interruption of lymphatic filariasis and onchocerciasis in previously endemic regions of Mali. This rapid diagnostic tool demonstrated good performance in 6 of districts in 2 “so-called’ evaluation units. There was very good overlap of the serological results obtained by the rapid diagnostic test (RDT) and previous endemicity profile of the different study districts for the two infections. We would argue that this RDT could be a single integrated approach for assessing transmission in areas where lymphatic filariasis and onchocerciasis are/were co-endemic.

Background In Mali, the burden of epilepsy is underestimated due to socio-cultural barriers that keep most people with epilepsy out of the local health facilities. The objective of this study was to evaluate the performance of trained community health workers (CHWs) in identifying epilepsy cases (active case detection) as compared to the passive cases detection (PCD) during outpatient visits at the community health centers in the health districts (HDs) of Kolokani, Kayes, Kenieba, Sikasso, Kadiolo, and Tominian. Methods A two-phase cross-sectional study was conducted from February to December 2019. In phase 1, trained CHWs conducted a census in 1017 villages organized into 174 community health centers which are part of the six study HDs to identify suspected epilepsy cases (SEC). Investigators used a modified epilepsy screening questionnaire from a validated standard questionnaire with the following three (3) questions: (i) Does or did the subject have a loss of consciousness and/or a loss of urine and/or drooling? (ii) Does or did the subject have an uncontrollable shake or abnormal movements of limb(s) (convulsions), with sudden onset and duration of a few minutes? (iii) Has or had the subject ever been told that he or she has epilepsy? During phase 2, neurologists confirmed the supposedly SEC (censed by the CHWs) in the first 30 villages with the highest number of SEC in each HD that were reported during phase 1. Results Of a total of 4830 SEC, 422 (10%) were identified by PCD during routine outpatient visits and 4408 (90%) through the active case detection (ACD) using the trained CHWs. The majority of SEC reported by the CHWs (PCD) were confirmed by neurologists, i.e. 82.9% (1645/1985). Phenobarbital was available in only 26 (14.9%) of the 174 surveyed health centers. Confirmed cases of epilepsy were reported in all the 174 health centers with prevalence varying from 91/100,00 to 285/100,000. Conclusion Active case detection of epilepsy using trained CHWs is an effective approach for epidemiological studies of epilepsy in the community settings as compared to the passive approach.

Background The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. Clinical trial registration NCT03044899.

This prospective survey was conducted from February to December 2014 about the use ceftriaxone (ceftriaz) for antibioprophylaxy concerning 300 patients by the surgery staff in the Gabriel Toure Teaching Hospital in Mali. The quantity of drug used was based on the weight of the patient. One dose was administrated in intravenous at the anesthesiology induction time. For more than 2 hours of intervention time, 4 (1.3%) patients received a second dose. The majority of cases (189, 63%) were out of emergency (emergency cases—111, 37%). The mean age was 41.6 years (range: 3 - 95 years). The patients were classed Altmeir II 203 (67.7%) and Altmeir I 97 (32.3%). The NNISS score 0 concerned 101 (33.6%) and NNISS 1 in 180 (60%) patients. The factors of risky were anemia (38; 12.7%), diabetes (6; 2%), and HIV (3; 1%). The mean of intervention duration was 56.8 ± 27.5 minutes. Four cases of intervention site infection were encountered caused by Pseudomonas aeruginosa in 2 patients; Escherichia coli (1 case), and Staphylococcus aureus (1 case). Conclusion: Antibioprohylaxy is not the only way to prevent infections but it stays necessary. The respect of hygien and aseptic measures should be used to reduce the rate of intervention site infection.

Intestinal volvulus on mesenteric cysticum lymphangioma (CL) is rare in children. The clinical picture is not very suggestive. We report a case of intestinal volvulus on CL in a 7-year-old girl after an abdominal trauma. Resection and anastomosis were made. The confirmation diagnosis was done by anatomopathological examination. Early diagnosis of intra-abdominal CL will allow avoiding complication.

En 2011, les décès périnatals représentent 41% des décès avant cinq ans. Notre objectif principal était d"étudier les déterminants de la mortalité périnatale chez les femmes présentant des complications obstétricales au CSRéf (Centre de Santé de Référence) de Kéniéba, Kayes. Nous avons mené une étude transversale, descriptive et analytique du 1er janvier 2008 au 31 décembre 2011. La taille de l"échantillon était égale à 213 obtenu à partir d"Epi6. L"analyse statistique a été faite avec SPSS. Les mesures ont été comparées par des analyses croisées simples et la régression logistique. Les valeurs de X2, des rapports de côte (RC) et du p ont été utilisées pour interpréter les résultats. La fréquence de la mortalité périnatale était de 41,5%. L"analyse uni-variée a été attestée par la multi-variée dont les résultats sont les suivants : la classe de moins de 18 ans a un effet protecteur de 0,19 l"IC à 95% (0,065-0,57) par rapport à la classe d"âge>30,5 ans p=0,003. Les référées ou évacuées ont 4,42 fois plus de risque d"avoir des décès périnatals par rapport aux venues d"elles-mêmes, l"IC égal (1,6-8,75).Les hémorragies étaient à 3,55 fois de risque de décès périnatals, l"IC égal (1,09-12,7). Au terme de cette étude, il apparait que les décès périnatals (41,5%) constituent un problème de santé publique dans le district sanitaire de Kéniéba. Ainsi la classe de moins de 18 ans a un effet protecteur de 0,19 l"IC à 95% (0,065-0,57). Les référées ou évacuées ont un risque de 4,42 d"avoir des décès périnatals ainsi que l"hémorragie dont le risque est aussi de 3,55.

L"objectif était de tester une méthode simple adaptée à un contexte de ressources limitées pour mesurer l"observance et identifier les motifs de non observance rencontrés dans le suivi des traitements antirétroviraux (ARV) en milieu décentralisé au Mali. Il s"agissait d"une étude transversale de juin 2006 à décembre 2008 chez des patients VIH suivis en consultation dans l"Unité de Soins et d"Accompagnements et de Conseils (USAC) de Koulikoro.. C"est ainsi que l"observance pour les ARV a été mesurée. Les patients ont été considérés comme observants si d"après le nombre de comprimés restants ils n"ont sauté aucune prise de leur traitement. L"étude a porté sur 250 patients. La tranche d"âge 30 à 34 ans était la plus représentée dans la série avec 17,6%. La majorité des patients était de sexe féminin soit 75,1%. La majorité de patients résidait dans la commune urbaine de Koulikoro soit 74,4%. Le schéma 2 Inhibiteurs Nucléosidiques de la Transcriptase Inverse (INTI) + 1Inhibiteur Non Nucleosidique de la Transcriptase Inverse (INNTI) était le plus prescrit soit 91,6%. Tous les patients étaient sous traitement ARV, avec 78% sous Triomune (Lamivudine + Stavudine + Nevirapine en combinaison fixe). Les patients qui ont fait un abandon (ou refus) de prendre le médicament étaient majoritaires avec 27,4%. L"observance était de 75,2%. L"indice global d"observance donne 188 patients (75,2%) comme observants et 62 patients (24,8%) comme non observants. L"observance thérapeutique dans l"étude est relativement bonne (75,2 % des patients). Cette étude montre que la mesure de l"observance est possible et faisable en utilisant le comptage des comprimés des patients en milieu décentralisé. Les causes d"inobservances étaient dominées par le refus (27,4%) ; l"oubli (24,2%) ; le voyage (16,1%) ; les effets indésirables des antirétroviraux de type allergique (12,9%). Notre étude a montré que 24,8% des patients ont été non observants en raison du refus,de l"oubli, du voyage et des effets indésirables. Les prestataires ou agents de santé avaient eu plusieurs astuces pour améliorer l"observance des patients telles que relier la prise du traitement à une activité quotidienne ou avant le petit déjeuner. Les associations des PVVIH œuvrent auprès des agents de santé afin de faire accepter aux nouveaux inclus leur statut et surtout le traitement ARV. Mots clés : VIH, Observance, ARV, Koulikoro.

Nous avons realise une etude retrospective de janvier 1999 a decembre 2010 incluant tous les patients operes ou non, hospitalises pour traumatisme de la rate dans le service de chirurgie generale du CHU Gabriel Toure.

Le volvulus du sigmoide est une urgence medicochirurgicale frequente. Le choix entre colectomie en urgence et colectomie en 2 temps est sujet de controverse. Determiner la frequence du VS, decrire ses aspects diagnostiques et analyser les suites operatoires. Il s’agit d’une etude retrospective qui a porte sur 10 ans (janvier 2000 — decembre 2009). Elle a ete effectuee dans le service de chirurgie generale au CHU Gabriel Toure de Bamako (Mali). Tous les malades operes pour volvulus du sigmoide sans necrose ont ete retenus. Les VS avec perforation intestinale ont ete ecartes. Au total 138 patients ont ete retenus et repartis en 3 groupes: Il s’agissait de116 hommes (84,06%) et 22 femmes (15,94%).l’âge moyen etait de 40,14 ans. La triade de Von Wahl etait presente chez 95 patients (68,84%). Quatre vingt quinze patients (68,84%) avaient a l’ASP un niveau hydroaerique en double jambage. La duree moyenne de l’intervention a ete de: 50 mn pour la detorsion simple; 100 mn pour la colostomie; 105 mn pour la colectomie ideale, et 90 mn pour la sigmoidectomie differee a froid. Les suites etaient simples chez 32 patients (91,45%) dans le groupe 1 contre 93 patients (93,93%) dans le groupe 3. Il n’avait pas de difference statistique entre les suites dans ces 2 groupes (Test de Yate p=0,90). Nous avions enregistre 3 cas de suppuration parietale, 4 cas de fistule digestive (2,90%) qui ont tari au cours du sejour hospitalier. La mortalite a ete de 2,17% soit 1 deces dans chaque groupe. Ces deces sont survenus chez des patients d’âge superieur a 70 ans dans un tableau d’insuffisance cardiaque decompensee. La duree moyenne d’hospitalisation a ete de 11,26 jours. Le volvulus du sigmoide est une urgence frequente. La colectomie ideale ne presente pas de risque supplementaire.

Longtemps consideres comme non prioritaires en Afrique subsaharienne, les cancers tendent a devenir un probleme de sante publique sur le continent, a l’instar des pays developpes. Objectif : evaluer, apres six ans de recul, l’epidemiologie et les resultats de la prise en charge des enfants atteints de cancer a l’unite d’oncologie pediatrique du CHU Gabriel-Toure de Bamako (Mali). Methodologie : tous les enfants d’âge inferieur ou egal a 15 ans atteints de cancer et ayant recu une chimiotherapie entre le 1er janvier 2005 et le 31 decembre 2010 ont ete inclus dans l’evaluation. Resultats : 690 enfants ont ete ainsi inclus. L’âge moyen etait de 24 mois (extremes : 6 mois-15 ans). Le delai de consultation etait inferieur a trois mois dans 200 cas (29 %), compris entre trois et dix mois dans 256 cas (37,1 %), et superieur a dix mois dans 234 cas (33,9 %). Les cinq premiers cancers pediatriques etaient, par ordre de frequence decroissante, les lymphomes malins non hodgkiniens : 231 cas (33,5 %), le retinoblastome : 170 cas (24,6 %), le nephroblastome : 102 cas (14,8 %) : les leucemies aigues lymphoblastiques : 54 cas (7 %) et la maladie de Hodgkin : 34 cas (4 %). L’hepatoblastome et les tumeurs germinales malignes etaient les moins representes. Apres six ans d’activite de notre unite, et un suivi moyen de trente-six mois (extremes 3-70), nous avons enregistre 272 deces (39,4 %) ; 238 patients etaient vivants (34,5 %) et 180 etaient perdus de vue (26,1 %). Conclusion : le taux de survie des enfants atteints de cancer au Mali reste encore faible avec un nombre tres eleve de perdus de vue.

RésuméObjectifPrésenter l’histoire naturelle des mégauretères primitifs de type obstructif, réévaluer notre attitude thérapeutique face aux différentes étiologies et situations du patient.Patients et méthodesNous avons revu rétrospectivement 30 enfants de 0 à 15ans entre Janvier 1996 et février 2008, suivis et traités dans le service pour mégauretère primitif de type obstructif : 16 enfants ont bénéficiés d’un diagnostic anténatal (groupe A) contre 14 enfants de diagnostic post-natal (groupe B). Ces patients ont été explorés par une échographie de l’appareil urinaire, une cystographie rétrograde et mictionnelle, une scintigraphie et une Imagerie par résonance magnétique.Résultatsl’étude a porté sur 30 enfants dont 25 garçons. L’age moyen du groupe A était de 32semaines et 3jours d’aménorrhée contre 4ans dans le groupe B. Le mégauretère était à gauche dans 48% des cas, 30% à droite et bilatéral dans 22%. Le mégauretère était obstructif non refluant dans 87% des cas, et obstructif refluant dans 13%. Le délai de suivi de nos patients de groupe A était de 4,2±1,4ans et le groupe B : 3,6±1,2ans. La dilatation urétérale rétrovésicale a régressé spontanément dans 50% des cas au cours des 2 premières années de vie. Une correction chirurgicale a été nécessaire chez 63% de nos patients.Conclusioncette étude a permis de montrer l’intérêt du diagnostic précoce et de la surveillance clinique et radiologique, proposée en 1ère intention, dans la prise en charge du mégauretère et pouvant entraîner la résolution spontanée du mégauretère.AbstractObjectivesTo present the natural history of primary obstructed megaureters, and to reassess the therapeutic approach towards patients based on both the natural history and the etiologies of the disease.Subjects and methodsWe conducted a retrospective review of 30 children between newborn and 15 years of age who were followed and treated for primary obstructed megaureters between January 1996 and February 2008 in the department of urology at the Point G hospital. They were divided into 2 groups based on etiology: group A included 16 children with an antenatal etiology and group B included 14 children with a post-natal etiology. The patients were evaluated by ultrasound of the urinary system, voiding cystourethrography, scintigraphy, and magnetic resonance imaging.ResultsOf the 30 children included in the study 25 were males. The mean age in group A was 32 weeks and 3 days of gestation, and 4 years in Group B. The megaureter was located on the left side in 48% of cases, on the right side in 30%, and was bilateral in 22%. The megaureter was obstructed and nonrefluxing in 87% of cases, obstructed and refluxing in 13%. The follow-up period was 4.2 ±1.4 years in group A and 3.6 ±1.2 years in group B. Half of the patients had a spontaneous regression of their retrovesical ureteral dilation within the first 2 years of life. A surgical procedure was required for 63% of the patients.ConclusionThis study showed the importance of early diagnosis, and clinical and radiologic surveillance as a first step in the care of megaureters. A conservative approach can result in the spontaneous resolution of the megaureter.

After seven annual rounds of mass drug administration (MDA) in six Malian villages highly endemic for Wuchereria bancrofti (overall prevalence rate of 42.7%), treatment was discontinued in 2008. Surveillance was performed over the ensuing 5 years to detect recrudescence. Circulating filarial antigen (CFA) was measured using immunochromatographic card tests (ICT) and Og4C3 ELISA in 6–7 year-olds. Antibody to the W. bancrofti infective larval stage (L3) antigen, Wb123, was tested in the same population in 2012. Microfilaraemia was assessed in ICT-positive subjects. Anopheles gambiae complex specimens were collected monthly using human landing catch (HLC) and pyrethrum spray catch (PSC). Anopheles gambiae complex infection with W. bancrofti was determined by dissection and reverse transcriptase polymerase chain reaction (RT-PCR) of mosquito pools. Annual CFA prevalence rates using ICT in children increased over time from 0% (0/289) in 2009 to 2.7% (8/301) in 2011, 3.9% (11/285) in 2012 and 4.5% (14/309) in 2013 (trend χ 2 = 11.85, df =3, P = 0.0006). Wb123 antibody positivity rates in 2013 were similar to the CFA prevalence by ELISA (5/285). Although two W. bancrofti-infected Anopheles were observed by dissection among 12,951 mosquitoes collected by HLC, none had L3 larvae when tested by L3-specific RT-PCR. No positive pools were detected among the mosquitoes collected by pyrethrum spray catch. Whereas ICT in 6–7 year-olds was the major surveillance tool, ICT positivity was also assessed in older children and adults (8–65 years old). CFA prevalence decreased in this group from 4.9% (39/800) to 3.5% (28/795) and 2.8% (50/1,812) in 2009, 2011 and 2012, respectively (trend χ 2 = 7.361, df =2, P = 0.0067). Some ICT-positive individuals were microfilaraemic in 2009 [2.6% (1/39)] and 2011 [8.3% (3/36)], but none were positive in 2012 or 2013. Although ICT rates in children increased over the 5-year surveillance period, the decrease in ICT prevalence in the older group suggests a reduction in transmission intensity. This was consistent with the failure to detect infective mosquitoes or microfilaraemia. The threshold of ICT positivity in children may need to be re-assessed and other adjunct surveillance tools considered.

Evaluer les resultats du traitement chirurgical du cancer de l’estomac. Etude retrospective de janvier 1999 a decembre 2008 portant sur tous les malades operes pour cancer gastrique dans le service de chirurgie generale du CHU Gabriel Toure. Les variables etudiees ont ete: l’âge, le sexe, les stades d’evolution et les suites operatoires. Nous avons enregistre 342 cas de cancer gastrique soit 53,7% des cancers digestifs. Deux tiers des malades etaient de sexe masculin. L’âge moyen etait de 51,8 ans (12,9). Chez 316 malades (94 %) le cancer etait diagnostique au stade III et IV. Le siege antral a ete le plus frequent 298 cas (87,1 %). L’echographie abdominale et la radiographie thoracique de face ont ete realisees chez tous les patients. Elles ont revele 38 metastases hepatiques, 58 cas d’ascite et 6 metastases pulmonaires. La chirurgie palliative a ete effectuee chez 167 patients (153 fois la gastro-enteroanastomose, 12 gastrostomies d’alimentation et la jejunostomie 2 fois). La chirurgie a visee curative a ete realisee chez 84 malades (24,6 %). Chez 13 patients seule une biopsie a ete possible a la laparotomie. La morbidite postoperatoire a ete de 9,8% soit 21 cas d’abces de paroi, 3 eviscerations et 2 fistules digestives externes. La mortalite postoperatoire immediate a ete de 3,8 % (10 cas). Parmi les 78 malades non operes 61 (78,2 %) sont decedes au cours du 1er mois du diagnostic. La duree moyenne d’hospitalisation a ete de 14,6 jours (9,5 jours). Le taux de survie a 5 ans a ete de 20,9 % apres chirurgie curative. Le cancer gastrique est le premier cancer en chirurgie digestive au Mali, son pronostic reste mauvais a cause du diagnostic tardif. Le cancer de l’estomac est le 2e cancer le plus frequent au Mali. Sa prise en charge est essentiellement chirurgicale.

Our study objectives were to determine annual cases of the tetanus and to describe its clinical, evolutionary and prognostic aspects. It was a transverse study from data records and medical records of patients aged 15 years and above hospitalized for tetanus in the service of infectious diseases of the Point G CHU from January 1, 2004 to December 31, 2009. The tetanus was diagnosed based on clinical (trismus, dysphagia, seizures and point consecutive to an injury) and epidemiological arguments (absence of a correct tetanus immunization, entry way). We collected a total of 119 cases of tetanus out of 1,839 hospitalizations making a prevalence of 6.5%. The hospitalization period was 5 days (73%) for most of the patients. Unskilled laborer and farmers were the most frequent with respectively 30.2 and 21.8% of cases. Tetanus occurred in the course of a traumatic road accident (16%) and from other traumatic causes (48.7%). The clinical form was a generalized type for 94.4% of the cases. A wound was the entry way for 64.7% of the patients. The entry way was located on the lower members 49.6% of the time. The co-morbidity was recorded with infection by Plasmodium falciparum (15 cases, 12.6%) and HIV (1 case). Hospital lethality was 46.2%. The death was statistically linked to clinical severity according to the Dakar score (P = 0.0005) and the Mollaret stage (P = 0.0001). A need for strengthening communication for behaviour change for the gaining of a correct and sustained immunization exists. A strategy based on the capacity building for a rapid tetanus diagnosis and a combined co-morbidities care may reduce the lethality in the context of our limited technical environment.

Dans le but d'étudier les aspects épidemio-cliniques et évolutifs des intoxications aigues aux médicaments et autres produits chimiques, une étude prospective non exhaustive, multicentrique, étalée sur une période de 12 mois, d'octobre 2009 au mois de novembre 2010 a été réalisée. Etaient concernés par cette étude, les patients admis dans les structures sanitaires CHU Gabriel Touré, Centre de santé de référence (csref) commune IV et V pour intoxication aiguë aux médicaments et autres produits chimiques sans distinction de race, d'âge, ou de sexe. La collecte des données s'est faite à partir d'une fiche d'enquête individuelle pour chaque patient, comportant l'identité de l'enquêté, mode d'admission, les circonstances de survenue, état du patient, indentification du produit incriminé, mode de présentation du produit, signes associés, conduites thérapeutiques et devenir du malade. 160 cas d'intoxication avaient été recensés. Les tranches d'âges les plus représentées étaient de 0 à 4 ans et de 20 à 24 ans avec respectivement 35,0% et 17,50 %. Dans 69,35 % le mode de survenue était accidentel. L'intoxication médicamenteuse était la plus incriminé (53,75 %) avec en tête la chloroquine (38,4%) suivi par le paracétamol (15,0 %). Les troubles digestifs et neurologiques dominaient le tableau clinique avec respectivement 40,9% et 32,50 %. L'évolution a été favorable dans 99,40%. L'intoxication est fréquente, le tableau clinique varié, la mortalité reste faible.

Le cancer de l’estomac est le deuxieme cancer le plus frequent au Mali. C’etait de decrire les aspects epidemiologiques et diagnostiques du cancer de l’estomac. Notre etude retrospective de janvier 1999 a decembre 2008 a porte sur tous les malades operes pour cancer gastrique dans le service de chirurgie generale du centre hospitalier universitaire (CHU) Gabriel-Toure de Bamako. Nous avons enregistre 342 cas de cancer gastrique, soit 53,7 % des cancers digestifs. Deux tiers des malades etaient du sexe masculin. L’âge moyen etait de 51,8 ans; l’ecart-type de 12,9; les extremes: entre 24 et 98 ans. Le mode de conservation alimentaire, la consommation de poisson fume et du to avec potasse ont ete les facteurs de risque suspectes. Les signes cliniques etaient l’epigastralgie (91,4 %); les vomissements (81,6 %); l’amaigrissement (96,8%) et une masse epigastrique palpable chez 30,4 % des malades. Chez 316 malades (94 %), le cancer etait diagnostique au stade TNM III et IV. Le siege antropylorique a ete plus frequent, 298 cas (87,1%). L’adenocarcinome a ete le type histologique le plus frequent (92,7 %); quatre cas de lymphome malin non hodgkinien et trois cas de tumeurs stromales ont ete retrouves. Le cancer gastrique est le premier cancer en chirurgie digestive au Mali, son pronostic reste mauvais a cause du diagnostic tardif.

Jadis toute contusion abdominale avec hemoperitoine etait justiciable d’un acte chirurgical. Mais depuis plus de deux decennies, avec l’avenement de l’echographie et de la tomodensitometrie, l’option non operatoire est de plus en plus preconisee. Les objectifs de notre etude etaient de determiner la frequence du traitement non operatoire (TNO) de l’hemoperitoine dans les traumatismes abdominaux fermes, d’identifier les etiologies avec les mecanismes de survenue, de decrire les signes cliniques, paracliniques et de determiner les indications du TNO. Il s’agissait d’une etude retrospective, descriptive, realisee de janvier 1999 a decembre 2008 en chirurgie generale au CHU Gabriel-Toure de Bamako (Mali). Ont ete inclus tous les patients admis pour traumatismes fermes de l’abdomen (TFA) avec hemoperitoine confirme par la clinique, la paraclinique et hemodynamiquement stables, en l’absence de lesion intestinale. Les cas de contusion abdominale avec instabilite hemodynamique ou une lesion intestinale associee ont ete exclus de l’etude. Nous avons collige 405 cas de TFA avec 270 cas d’hemoperitoine associes. Le TNO a porte sur l’expectative armee avec une surveillance clinique et paraclinique repetee. L’etude a porte sur 73 patients, dont 50 hommes (68,5 %) et 23 femmes (31,5 %) avec un sex-ratio de 2,26. La moyenne d’âge a ete de 20,53 ans. Les eleves etaient les plus exposes avec 40 cas (54,8 %). Le TNO a represente 18 % des TFA et 0,3 % de nos hospitalisations durant la periode d’etude (n = 23 887). Cinquante-six patients (76,8 %) ont ete admis avant les six premieres heures apres le traumatisme. La pâleur conjonctivale et l’hypotension arterielle ont ete retrouvees respectivement chez 26 (36 %) et huit (11 %) des patients. Nous avons observe une stabilite hemodynamique chez 65 malades (89 %) a l’admission et huit cas (11 %) d’instabilite ayant repondu favorablement a une reanimation initiale. Les accidents de la voie publique (AVP) 44 cas (60,3 %) et les chutes 14 cas (19,2 %) etaient les principales etiologies. L’hemoperitoine etait de faible abondance 36 cas (49,3 %), de moyenne abondance 34 cas (46,6 %) et de grande abondance trois cas (4,1 %). L’ASP a ete realise chez tous les patients (100 %) et n’a pas retrouve de pneumoperitoine. A l’echographie, la rate a ete l’organe le plus lese 21 cas (28,8 %) contre dix cas (13,7 %) pour le foie et trois cas (4,1 %) pour le rein. Sept patients (9,6 %) ont pu beneficier du scanner, dont trois cas de lesions spleniques de grade II, deux cas de lesions hepatiques de grade II, un cas de lesion renale de grade II. Six malades (8,2 %) ont ete transfuses. Les suites ont ete simples dans 66 cas (90,4 %), et l’echec therapeutique a ete observe chez sept patients (9,6 %) operes secondairement. La mortalite a ete nulle. Le sejour moyen hospitalier etait de 7,8 jours. Actuellement, le TNO peut etre preconise chez tout patient hemodynamiquement stable en l’absence d’une lesion intestinale associee. Il permet de limiter le nombre de laparotomies blanches et les risques lies a l’acte chirurgical.

Le diagnostic des cancers abdominaux de l’adulte est tardif. Nous avons determine la frequence hospitaliere et analyse les aspects diagnostiques et therapeutiques. Notre etude retrospective a dure de janvier 1999 a decembre 2004. Elle a concerne les patients âges de plus de 14 ans, traites en chirurgie generale du CHU Gabriel-Toure pour une tumeur abdominale maligne confirmee par l’histologie ou la cytologie. Les tumeurs de l’œsophage et les tumeurs non confirmees ont ete exclues. Nous avons collige 152 dossiers de tumeurs malignes de l’abdomen. L’âge moyen des malades a ete de 54,4 ± 14 ans. La serie comprenait 86 hommes et 66 femmes. Les tumeurs siegeaient: sur l’estomac chez 90 malades (59,2 %), le pancreas chez 22, le colon chez 17, le rectum chez 14, l’ovaire chez cinq et le foie chez quatre malades. Le sejour hospitalier a dure en moyenne 24 jours. Les signes cliniques retrouves ont ete la douleur abdominale dans 78,9 %, les vomissements 81 fois (53,3 %) et une masse abdominale dans 17,8 %. Cent dixsept malades etaient operables. Trente-cinq ont beneficie d’une intervention a visee curative, 72 a visee palliative, 45 etaient inoperables. L’histologie a revele 90 % d’adenocarcinomes. La morbidite et la mortalite postoperatoires ont ete de 6 et 7,7 %. La survie globale a cinq ans a ete de 6 % (sept malades). Le cout moyen du traitement chirurgical a ete de 158 745 F CFA.

Resume Les perforations typhiques restent une cause frequente de peritonite dans les pays en developpement. Nos objectifs ont ete de determiner la frequence hospitaliere, de decrire les signes cliniques et paracliniques, d’analyser les suites operatoires. Nous avons realise une etude retrospective qui a porte sur une periode de dix ans (janvier 1999–decembre 2008) dans les services de chirurgie generale et pediatrique du CHU Gabriel-Toure. Elle a porte sur tous les malades operes pour peritonite par perforation typhique. Nous avons collige 385 perforations typhiques, soit 32,5 % des peritonites toute cause confondue. C’etait 136 femmes (35,4 %) et 249 hommes (64,6%), l’âgemoyen a ete de 15,2 ± 11,6 ans (2–65 ans). Deux cent cinquante patients (64,93 %) avaient entre 2 et 15 ans, 64 malades (16,62 %) avaient deja ete traites pour fievre typhoide. Le sejour hospitalier a dure en moyenne 18,4 jours (ET = 6,5). La radiographie de l’abdomen sans preparation realisee chez 221 avait une sensibilite de 70,59 %, la sensibilite du Widal a ete de 82 %. Les organes perfores etaient les suivants: ileon 367 (95,32 %); colon 9 (2,34 %) et vesicule biliaire 9 (2,34 %). L’excision-suture a ete realisee 273 fois, 44 resections-anastomoses en un temps, 54 ileostomies, neuf cholecystectomies et cinq hemicolectomies droites avec ileostomies. La mortalite a ete de 8,33 % et la morbidite de 21,56 % (61 abces de parois, huit fistules digestives, sept peritonites postoperatoires, sept eviscerations postoperatoires). Les suites n’ont pas ete influencees par la technique operatoire.

Resume Objectifs Determiner la frequence des infections nosocomiales, identifier leurs facteurs de risque et determiner les germes en cause et leurs sensibilites. Materiel et methodes Il s’agissait d’une etude prospective realisee de 1er janvier au 31 decembre 2007 sur tous les patients hospitalises dans le service de chirurgie pediatrique pendant au moins 48 heures. Les enfants dont l’hospitalisation etait inferieure a 48 heures et les patients perdus de vue n’ont pas ete inclus. L’infection nosocomiale a ete identifiee selon les criteres definis par Center for Disease Control (CDC) d’Atlanta. Resultats La frequence etait de 7,4 %. L’âge moyen de nos patients etait de 8,7 ans. Le sex-ratio etait de 1,66 en faveur des garcons. Le mode de recrutement, le score de National Nosocomial Infection Surveillance System (NNISS), la classification d’Altemeier, le mode d’intervention et la duree d’hospitalisation ont ete des facteurs determinants dans la survenue des infections nosocomiales, avec p

Etablie comme cause majeure de tumeur de la sphere urogenitale dans certains pays, la bilharziose a tres peu ete etudiee au Mali par rapport a cet aspect. Pour determiner les caracteristiques des tumeurs urologiques dans une zone endemique pour la bilharziose urinaire, nous avons entrepris, en zone rurale de culture irriguee, une enquete transversale. Elle a permis d’examiner des sujets vivant en zone d’endemie sur le plan parasitologique, clinique, echographique et biologique. La microhematurie avec 46 % (295/639 sujets), et la macrohematurie avec 19 % (141/719 sujets), ont ete retrouvees dans la population d’etude. Quinze cas de tumeurs vesicales ont ete rencontres chez des adultes hommes et femmes, âges de 35 a 62 ans. Un examen anatomopathologique des pieces operatoires, realise chez 11 de ces patients, a revele qu’il s’agissait essentiellement de cancer epidermoide. Au niveau du tractus urinaire superieur, 24 cas d’hydronephrose moderee (3,3 %) et 17 cas d’hydronephrose majeure (2,3 %) ont ete observes. Un score de 6 a 24, selon le Protocole de Niamey, a ete observe chez 31 patients, soit 4,2 %. Ces prevalences sont assez considerables, vu la proportion de tumeurs cancereuses parmi celles retrouvees dans cette zone endemique pour la bilharziose. Bien que d’autres investigations soient necessaires pour mieux caracteriser les tumeurs decrites, ces observations font ressortir le probleme de sante publique que constituent les lesions malignes causees par l’infection chronique par Schistosoma haematobium (S. haematoium) en zone de culture irriguee au Mali.

Objective : To study the etiologies, therapeutic and prognosis factors of coma in the elderly in the Department of Anesthesia and Intensive Care of Gabriel TOURE Teaching Hospital, Mali. Materials and Methods: This was a prospective descriptive study of all cases of coma in the elderly, registered from February 1, 2008 to January 31, 2009 at the Department of Anesthesiology CHU Gabriel Toure, Bamako. Results: During the study period, 564 patients were admitted to the intensive care unit (ICU) in which 174 (30.85%) were older people. We collected 100 subjects with impaired consciousness, the object of our study, which represented 17.73% of all admissions in the Department of Anesthesiology during the study period and 57.47% of all admissions of older people; 66% of our subjects were male. Hypertensive patients accounted for 60% of cases. In 46% of cases, it was a coma from cardiovascular causes and in 28% of cases; it was a coma of metabolic origin. The diagnoses made in the wake of the care of the elderly in ICU were predominantly stroke (46%) and electrolyte disturbances (13%). The coma was sudden onset in 58% of cases, including 28 cases of stroke whether 48.27%. The prognosis was marked by a fatality with 51% of deaths in our sample. Conclusion: The prognosis improvement of the elderly in coma through to the introduction of proxy measures.

Resume Objectifs. – Evaluer l’impact des modalites de prescriptions d’antalgiques sur la douleur postoperatoire a domicile apres chirurgie de la main realisee en urgence en hospitalisation de jour. Type d’etude. – Etude prospective comparative, avant/apres par interrogatoire telephonique a j1 postoperatoire. Patients. – Tous les patients d’un service « SOS main » universitaire operes en urgence en chirurgie de jour sur une periode de 2 mois. Methodes. – a) Enquete avant (120 patients) : analyse des pratiques analgesiques en vigueur dans le service (prescriptions effectuees par le chirurgien de garde), evaluation de l’incidence des scores de douleur d’intensite ≥ 4 sur une echelle numerique graduee entre 0 et 10 et identification des chirurgies les plus douloureuses ; b) elaboration pour ces chirurgies de protocoles antalgiques multimodaux rediges par les anesthesistes ; c) enquete apres (51 patients) : evaluation de l’efficacite antalgique des protocoles par comparaison avant/apres. Resultats . – a) Enquete avant : l’incidence globale des scores de douleur d’intensite ≥ 4 etait de 42 % alors qu'elle atteignait 88 % dans le sous groupe de patients atteints de lesions osteo-articulaires ou septiques. L’association dextropropoxyphene–paracetamol constituait 66 % des prescriptions conduisant a 48 % d’echec d’analgesie. Les anti-inflammatoires et le tramadol etaient prescrits dans respectivement 14 % et 7 % des cas. Une bitherapie etait retrouvee dans seulement 15 % des cas ; b) enquete apres l'incidence des douleurs d’intensite ≥ 4 a ete reduite a 21 % dans les chirurgies osteo-articulaires ou septiques (p Conclusion . – L’analgesie multimodale adaptee est plus efficace que les prescriptions libres et souligne le besoin de formation des chirurgiens prescripteurs. Malgre ces protocoles ecrits, il persiste 21 % de douleurs a domicile a j1.

Objectives: The aims of this study was to evaluate the management of lesions in victims of the malian conflict patients admitted to Niamey hospitals. Methods: A retrospective study was conducted in Niamey hospitals from January 1st, 2012 to December, 31th, 2013. Data collected included âge, sex, means of transport, topography of trauma, treatment and outcome. Results: The sample included fifty one (51) patients. All patients were male; the mean age was 29,5 years ± 9 years, ranging from 17-71 years. The age between 26 and 35 were most affected in 47% of cases (24 patients), soldiers represented 72.54% (37 patients); and civils 27.45% (14 patients). 74.50% of our patients (38) were been transported in Niamey by aircraft. The trauma concerned the members in 54.90% (28 cases), canio facial in 17.60% (9 cases), abdomen in 11.80% (6 cases). We observed only one polytrauma. 66.66% (34) of patients were injured by firearms, 29.41% (15) by accidents of roads, 3,93% by burn (2 patients). The lesions found were bone in 41.17% (21 patients), skin-muscle in 35.29% (18 patients), visceral in 9.80% (5 patients). Five patients died (9.80%). Conclusion: the internationalization of conflicts requires a reorganization of the care by involving all the nearness health structures in order to ensure adequate care and neutrality.

Objectives The objectives of this study were to determine the frequency of perforations and to describe the clinical, diagnostic and therapeutic aspects of traumatic perforations of intra-abdominal hollow organs in the general paediatric surgery unit of Gabriel-Toure teaching hospital.

Association of gastric cancer and breast cancer is rare. The determination of the secondary character of gastric cancer remains difficult in Africa. We report the observation of a 53-year-old woman who presented with vomiting, weight loss, and anemia 16 months after the appearance of breast tumor. The examination found an inflammatory tumor in the right breast and right axillaries nodes, with abdominal pain. After histological examinations we concluded gastric linitis associated to a breast ductal carcinoma. The patient was treated with tamoxifene; survival was of three months. Association of gastric cancer and breast cancer are not to be ignored. Extensive examinations must be carried out to determine the primitive or secondary character gastric cancer.

A six-month prospective surveillance study of postoperative surgical site infections (SSIs) was undertaken between January and June 2010 in paediatric patients aged15 years, in the University Hospital Gabriel Touré, Mali. SSI was documented in 43 out of 352 children (12.2%). SSIs were significantly more common after emergency operations, in patients with a National Nosocomial Infection Surveillance System (NNISS) score of 2 or 3, and in patients operated on by trainee rather than by experienced surgeons. Children with anaemia or malnutrition were significantly more likely to develop infection postoperatively. Patients' sex, duration of preoperative stay and the number of patients in the hospital room were not considered as risk factors for infection (P0.05).

Mansonella perstans infection is common in areas of Africa where Wuchereria bancrofti, a causative agent of lymphatic filariasis, is endemic. M. perstans is refractory to standard antifilarial therapies. The recent discovery of bacterial endosymbionts (e.g., wolbachia) in most filarial species, including M. perstans, provides new therapeutic options for reducing microfilaremia.In an open-label, randomized trial, we recruited subjects with M. perstans microfilaremia, with or without concomitant W. bancrofti infection, from four villages in Mali and randomly assigned them to receive doxycycline, at a dose of 200 mg daily for 6 weeks (106 subjects), or no treatment (110). At 6 months, subjects who were coinfected with W. bancrofti underwent a second random assignment, to treatment with a single dose of albendazole (400 mg) and ivermectin (150 microg per kilogram of body weight) or no treatment. Subjects were monitored daily during the first 6-week study period for adverse events. M. perstans and W. bancrofti microfilarial levels were assessed at 6, 12, and 36 months.At 12 months, 67 of 69 subjects who had received treatment with doxycycline only (97%) had no detectable M. perstans microfilariae per 60 microl of blood, as compared with 10 of 63 subjects who had received no treatment (16%) (relative risk, 6.18; 95% confidence interval, 3.63 to 11.89; P0.001). At 36 months, M. perstans microfilaremia remained suppressed in 48 of 64 subjects who had received treatment with doxycycline only (75%), a finding that was consistent with a macrofilaricidal effect of doxycycline. Vomiting was more frequent in the doxycycline-treated group than in the untreated group (17% vs. 4%).These results are consistent with previous findings that M. perstans harbors the intracellular endosymbiont, wolbachia, and suggest that doxycycline is an effective therapy for M. perstans infection. (ClinicalTrials.gov number, NCT00340691.)

Objective: To evaluate nutritional status and dietary intakes in HIV-outpatients in Abidjan, Cote d’Ivoire. Design: Cross-sectional study. Setting: In the Outpatients and Counselling Unit in the University Hospital in Treichville, and in the follow-up Unit of Blood Donors. Subjects: 100 HIV-infected patients at different stages of the infection recruited consecutively in the two consultation services. Main outcome measures: Clinical, biological and anthropometric data were collected: weight, baseline weight, height, triceps skinfold (TS), arm circumference (AC), body mass index (BMI), muscular circumference (MC) and weight loss (WL). Dietary intake was estimated by the 24 h recall method. Results: The M:F sex ratio was 1.1:1. Mean age was 32.5 y (30.7–34.4); 64% of the patients were symptomatic (S+). Mean weight was 58.7 kg (56.8–60.6) and mean BMI, 20.9 k/m2 (20.7–21.1); 67% of the patients had a BMI

During a prospective study conducted at the rehabilitation Center of the physically handicapped persons and at the mother-child Hospital in Bamako, the authors report 50 cases of neuromuscular complications of the quinine intramuscular injection in the child. The scan revealed muscular calcifications in 37 cases (740%), abscesses, in 7 cases (14%) and muscular inflammations in 6 cases (12%). Xray of the affected limb was not systematic: it has been performed in four children in the case of a subjacent bone involment. It showed calcifications in two cases. If muscular abscess is easily diagnosed by clinical exam it is not the case for calcifications. The scan allows to set up a precise mapping of the muscular lesions, to determine their type and size. It also helps the clinicians in their therapeutic attitude. Medical treatment associated with rehabilitation has been carried out in 40 patients (80%) and surgery in 10 patients (20%).